COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0337H.02C Bill No.:HCS for HB 336 Subject:Health, Public; Employees - Employers; Liability Type:Original Date:March 21, 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 reach the $250,000 threshold.
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.02C
Bill No. HCS for 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.02C
Bill No. HCS for 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 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
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. L.R. No. 0337H.02C
Bill No. HCS for HB 336
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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 University and its hospitals and health care facilities,
however it is not possible to identify a significant fiscal impact at this time.
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.
Officials from the St. Louis County Health Department assume this proposal could have a
negative fiscal impact of an undetermined amount.
Officials from the Kansas City Health Department assume this proposal could have a fiscal
impact of an indeterminate amount.
Officials from the Kansas City Police Retirement System and the Kansas City Civilian Police
Employees’ Retirement System each assume an unknown cost for this proposal.
In response to a previous version, officials from the Kansas City Supplemental Retirement
Plan assumed 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.
In response to a previous version, officials from the Missouri Western State University
assumed the impact is unknown because the amount of the litigation, if any, is unknown.
In response to a previous version, officials from the Northwest Missouri State University
stated 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.
In response to a previous version, officials from the Camden County Auditor’s Office assumed
a negative fiscal impact from this proposal.
Officials from the Little Blue Valley Sewer District
on their organization. They do require some immunizations for their employees, Hepatitis
A&B. There is not enough information included in this document to understand the liability of L.R. No. 0337H.02C
Bill No. HCS for HB 336
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the employer. Is it for all immunizations or is it just COVID. This need more clarification. It
could cost small districts millions..
Officials from the Metropolitan St. Louis Sewer District (MSD)Metropolitan St.
Louis Sewer District Employees Pension Plan (MSDPP) each assume this proposal would
have an impact to the extent that additional liability insurance would be needed to cover the new
risk. MSD and MSDPP does not have a cost estimate currently.
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, and 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.
In response to a previous version, officials from the Public Schools and Education Employee
Retirement Systems (PSRS/PEERS) assumed 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 RevenueDepartment of Public Safety
(Division of Alcohol and Tobacco Control, Capitol Police, Fire SafetyOffice of the
DirectorMissouri Gaming Commission, the Missouri Highway PatrolState
Emergency Management Agency, the Missouri Veterans Commission), the Missouri
National Guard, the Department of Social Services, the Missouri Department of
AgricultureMissouri Department of Conservation, the Missouri Ethics Commission,
the Missouri Department of TransportationMoDOT & Patrol Employees’ Retirement
System, the Office of the State Public DefenderOffice of the Governor, the Office of the
State Auditor, the Joint Committee on Administrative Rules, the Joint Committee on L.R. No. 0337H.02C
Bill No. HCS for HB 336
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Education, the Joint Committee on Public Employee Retirement, Legislative Research, the
Oversight DivisionMissouri Senate, the Missouri Lottery, the Missouri Consolidated
Health Care Plan, the Missouri Office of Prosecution Services, the Missouri State
Employee's Retirement System, the Office of the Lieutenant Governor, Missouri State
University 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 Kansas City, the City of Springfield, the Jackson County Board of
Elections, the Platte County Board of Elections, the St. Louis County Board of Elections, the
Newton County Health DepartmentLincoln County Assessor’s OfficeClay County
Auditor’s Office, the Phelps County Sheriff’s Office, the Kansas City Police Department,
the St. Joseph Police Department, the Branson Police DepartmentSt. Louis County
Police Department, the Eastern Clay Ambulance District, the County Employees
Retirement Fund, the Kansas City Employees’ Retirement System, the Kansas City
Firefighter’s Pension System, the Kansas City Public School Retirement System, the Public
Education Employees’ Retirement System, the Sheriff’s Retirement System, the St. Charles
County PWSD #2, the Wayne County PWSD #2, the 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 for these agencies.
In response to a previous version, officials from the Petroleum Storage Tank Insurance Fund,
the Missouri House of Representatives, the Missouri Higher Education Loan Authority, the
Office of the State Courts Administrator, the City of Claycomo, the City of O’Fallon, the St.
Louis City Board of Elections, the Christian County Auditor’s Office, the Hannibal Rural
Fire Protection District, the Cole Camp Ambulance District, the Nodaway County
Ambulance District, the Blackwater Reorganized Common Sewer District and the
Lexington Water/Wastewater
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 Gasconade County Assessor’s Office, Greene County, the Springfield Police
Department, the Carroll County 911 Board, the Crawford County 911 Board, the
McDonald County 911 BoardLake West Ambulance District, the Rock Community
FPD Retirement Plan, the Spanish Lake FPD Retirement Plan, the St. Louis City
Firefighter’s Retirement Plan, the St. Joseph Policemen’s Pension FundHoward
County C-PWSD #1, the Vernon County PWSD #7, the Hermann Area Hospital District,
the Hughesville Water/Wastewater District and the St. Louis-Jefferson Solid Waste
Management District
organizations. Oversight does not have any information to the contrary. Therefore, Oversight
will reflect a zero impact in the fiscal note for these agencies. L.R. No. 0337H.02C
Bill No. HCS for HB 336
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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,
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.02C
Bill No. HCS for HB 336
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LEGAL 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) L.R. No. 0337H.02C
Bill No. HCS for HB 336
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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
liable for damages or injury resulting from the required immunization.
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 L.R. No. 0337H.02C
Bill No. HCS for HB 336
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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
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 L.R. No. 0337H.02C
Bill No. HCS for HB 336
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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
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
Eastern Clay Ambulance District
St. Joseph Police Department
St. Louis County Health Department L.R. No. 0337H.02C
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Kansas City Employees’ Retirement System
Kansas City Firefighter’s Pension System
Metropolitan St. Louis Sewer District
Metropolitan St. Louis Sewer District Employees Pension Plan
Julie MorffRoss StropeDirectorAssistant DirectorMarch 21, 2023March 21, 2023