COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1261H.02C Bill No.:HCS for HB 489 Subject:Education, Higher; Health Care; Boards, Commissions, Committees, and
Councils; Professional Registration and Licensing
Type:Original Date:April 3, 2023Bill Summary:This proposal creates provisions relating to health care.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Total Estimated Net
Effect on General
Revenue$0 to (Unknown)*$0 to (Unknown)*$0 to (Unknown)*
*Oversight assumes the combined losses relating to DMH training sites and additional LEF
transfers could exceed the $250,000 threshold.
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Other State$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)LEF* $0$0$0Colleges and
Universities$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
Total Estimated Net
Effect on Other State
Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Indicates numbers net to $0.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Federal - CMS$0 to ($123,333,333)$0 to ($148,000,000)$0 to ($148,000,000)Federal – Veterans
Affairs**$0 to ($287,500,000)$0 to ($345,200,000)$0 to ($345,200,000)
Total Estimated Net
Effect on All Federal
Funds
$0 to (Unknown,
potentially exceeding
$410,833,333)
$0 to (Unknown,
potentially exceeding
$493,200,000)
$0 to (Unknown,
potentially exceeding
$493,200,000)
*Oversight notes DMH’s assumption of loss of federal funding for non-compliance with DEI
provisions and the resulting loss of facilities’ accreditations could be significant; DMH noted a
possible maximum loss of $148 million annually.
** Oversight notes MVC’s assumption of the potential loss of federal funding from the US
Department of Veterans Affairs due to Recapture Provisions of CFR 59.110 which allows the
VA to recover federal construction grant funds for non-compliance. The maximum recapture
amount could exceed $345 million annually.
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 to (Unknown)$0 to (Unknown)$0 to (Unknown) L.R. No. 1261H.02C
Bill No. HCS for HB 489
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FISCAL ANALYSIS
ASSUMPTION
§§191.230 and 292.648 – Refusal of medical procedures or treatment
Officials from the Department of Public Safety - Missouri Veterans Commission (MVC)
state MVC received approximately $59 million in per diem payments through the VA State
Veterans Homes Per Diem Grant Program during state fiscal year 21. If MVC does not comply
with federal regulations MVC would lose all of its federal funding and may lose its Recognition
and Certification as a VA State Skilled Care Home.
MVC currently holds contracts with entities that require COVID vaccinations for their
employees. Any company MVC hires who also receive reimbursement from CMS will be subject
to vaccination requirements. For example, their pharmacy vendor, skilled therapy vendor, dietary
service vendor, wound care vendor, hospice vendors, lab vendors, etc. MVC also has agreements
in place with the US Department of Veterans Affairs to provide care and service, they also
require vaccinations for employment. If MVC were prohibited from contracting healthcare
services with these vendors the MVC would assume financial responsibility for
hiring/contracting qualified independent professionals to perform these necessary services who
are not affiliated with or receiving reimbursement from CMS. MVC would have to close the
Veterans Homes if they could not contract the services listed above. This Fiscal impact could
exceed $75M.
CFR 59.110 “Recapture Provisions” allows the VA to recover the federal construction grant
funds if the facility does not maintain services previously specified in the construction MOU
between VA and MVC for 20 years.
Most projects take 2 years from start of design to end of construction. The 5 previous projects
total 28.7 million in federal dollars. The average revenue received over a 3 year period is
$9.55 million. An average calculation over the previous 20 years is $191 million.
In addition, the cost of the original construction of facilities constructed since 2000 is
approximately $68.8 million. Included in this number is the construction of all 5 Veterans
cemeteries, the Mt. Vernon Veterans Home, and the Warrensburg Veterans Home.
The language as it relates to the construction grant program could cost MVC in excess of $260
million in “Recapture Provisions”.
Oversight does not have any information to the contrary. Oversight assumes it is unlikely the
MVC will lose all federal funding under the Recapture Provisions but will range the potential
loss of Federal Funds as $0 to ($345,200,000) annually. L.R. No. 1261H.02C
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Officials from the Department of Mental Health (DMH) state this proposal adds §§191.230
and 292.648 prohibiting a public body and employers in the state from requiring individuals to
receive a COVID-19 vaccination. CMS expects all facilities’ staff to receive a 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 requirement may put some DMH facilities and agencies at odds with federal
requirements for licensure and/or CMS funding. These provisions will have an unknown impact
on DMH.
Oversight notes the DMH assume the proposal could affect their funding because the facility
staff vaccination rates under 100% constitute non-compliance (CMS guidance QSO-23-02-
ALL).
In response to a similar proposal (HCS HBs700 & 445), Oversight received additional
information from the DMH, via e-mail, and confirmed that officials from the DMH believe this
bill, considering the allowable exclusions, could still have a potential impact on the funding
reaching beyond $250,000, due to the loss of CMS funding.
Oversight notes the proposal, specifically §191.230.4 (1) thru (6), allows for exclusions of
certain organizations certified by the Medicare or Medicaid, and employees of state department
and agency who are part of an onsite survey team performing federal oversight of certified
providers and suppliers for the Centers for Medicare and Medicaid Services.
Oversight assumes both §§191.230 and 292.648 provide for exception which is applicable for
facilities defined in §199.170. The exceptions would effectively include the Department of
Mental Health facilities. Therefore, Oversight will reflect a zero impact in the fiscal note for
DMH for these sections of the fiscal note.
§§191.1770 through 191.1810 – Do No Harm Act
Officials from the Department of Mental Health (DMH) state the proposed legislation
establishes the “Do No Harm Act” under sections 191.1770 to 191.1810.
Section 191.1775(3) defines "health care provider" as "any public hospital or public health care
provider including, but not limited to, physicians' offices, outpatient clinics, medical testing sites,
medical laboratories, physical or occupational therapy or rehabilitation providers, chiropractors,
dentists, optometrists, mental health and clinical social workers, and related providers".
Section 191.1795 prohibits health care providers and medical institutions of higher education
from adopting or imposing any type of diversity-equity-inclusion (DEI) training, education,
material or program as a condition of obtaining or renewing licensing. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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Section 191.1800 would require any state entity applying for a federal health care grant related to
DEI to publish materials on their website and submit copies to the state board of registration for
the healing arts and to the legislative committees on health policy.
The DMH inpatient facilities are accredited by The Joint Commission (TJC) and Center for
Medicare/Medicaid Services (CMS). TJC and CMS set several standards that facilities are
required to meet for accreditation; cultural competency is included in seven areas of TJC
Standards and in three areas of CMS hospital Conditions of Participation. Loss of accreditation
by DMH facilities would result in the loss of federal funding. The fiscal impact is estimated to be
$0 to $148 million annually.
Additionally, DMH offers training for various clinical disciplines. Various regulatory bodies
oversee the training of these clinicians and specify the need to incorporate cultural competency.
For example, the Accreditation Council for Graduate Medical Education (ACGME) has
recognized cultural competency as a part of three out of six core competencies (patient care,
interpersonal and communication skills and professionalism) that residency training programs
are to provide training in. Loss of training sites would lead to further shortages in clinical
disciplines.
Also, DMH clinicians (psychiatrists, psychologists, social workers, nurses, etc.) have continuing
education requirements to maintain licensure to practice. Reducing acceptable types of
continuing education by excluding those that contain DEI, could result in DMH clinicians being
unable to attain the requisite amount of continuing education.
In addition, the Value Based Payment learning path follows the National Direct Support
Professional (DSP) best practices which includes multiple DEI trainings and would be in conflict
with the proposed language. In addition, this would impact DMH’s contracting process since
certification would have to occur prior to the award of a contract and subsequently may
negatively impact the Department’s ability to attract new providers. This could possibly cause a
safety issue to those individuals the DMH is in charge of care if at the last minute there are
providers DMH can no longer contract with. The term “certification” is not defined so it is
unclear as to what would be involved with the process and the effect on DMH’s workforce. This
may cause an unknown impact to the department.
Oversight does not have any information to the contrary. Oversight has no information on the
amount of federal funding that could potentially be lost. In addition, Oversight has no
information relating to the likelihood of a loss of training sites that could be used by DMH if
they offer DEI training. Therefore, Oversight will reflect $0 to Unknown costs to General
Revenue (assumed to be less than $250,000 annually) and a $0 to $148 million loss in federal
funding as a result of being out of compliance with federal provisions.
Officials from the University of Central Missouri (UCM) state this proposal may have an
indeterminate but considerable negative fiscal impact due to loss of student enrollment, and
potentially, degree programs. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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because it "receives state funds and offers health care-related degrees, health care-related
certifications, or health care-related training," including, under this legislation: Registered
Nursing BS, Family Nurse Practitioner MS, Medical Lab Science BS, Radiologic
Technology BS, and pre-med, pre-vet, pre-dental programs in Biology.
reference to group differences within a given setting with respect to culture, ethnicity,
gender, gender identity, national origin, race, religion, or sexual orientation."
medical needs vary by these specific characteristics.
students in the above degree programs.
Less impactful, but still notable, is the component that reads "Medical institutions of higher
education shall not conduct internal DEI audits or otherwise engage DEI consultants." This
would limit UCM's ability to conduct one key component of their strategic plan, goal 4:
"Inclusive and Diverse Community".
Oversight does not have any information to the contrary. Therefore, Oversight will reflect a $0
to unknown cost for colleges and universities for fiscal note purposes.
Officials from the Office of Administration (OA) state the provisions of §§191.1802 –
191.1805 have the potential to increase costs to the state Legal Expense Fund (LEF) for actions
alleging violation of this provision against a state employee in connection with their official
duties on behalf of the state or against another person covered by the LEF, due to the addition of
an enforceable right under this section. This provision also waives sovereign immunity. This
change will be subject to judicial construction; therefore, the cost impact to the state is unknown.
Oversight notes OA provided additional information relating to the LEF in response to similar
legislation from the current session (HCS HB 700 & 445). In that response, OA stated the state
self-assumes its own liability under the LEF, §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.
Because this bill creates a possible new cause of action, Oversight will show a net $0 direct
fiscal impact for the LEF, and a possible $0 to (unknown) fiscal impact to General Revenue and
other state funds. Oversight notes this possible litigation exposure as described by OA could also
apply to colleges and universities, federal funds, as well as local political subdivisions. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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Officials from the Office of Administration - Budget and Planning (B&P) state insofar as the
new penalties created by the bill result in fine revenues that are deposited into the state treasury,
the legislation would increase Total State Revenue (TSR).
Officials from the Office of Attorney General (AGO)
arising from this proposal can be absorbed with existing resources. However, the AGO may seek
additional appropriations if there is a significant increase in litigation.
Oversight does not have any information to the contrary. Therefore, Oversight assumes the
AGO will be able to perform any additional duties required by this proposal with current staff
and resources and will reflect no fiscal impact to the AGO for fiscal note purposes.
Oversight notes provisions in §191.1805.3 provide that the AGO may seek civil penalties up to
$1 million for violations. In addition, it is thought since these penalties would be for a violation
of civil law rather than criminal law, the penalties would not be distributed to school districts.
Oversight assumes any civil penalties collected by the AGO would be deposited in the General
Revenue Fund. Since it is unknown whether any penalties will be collected, Oversight will range
the penalties from $0 to Unknown.
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.
Bill as a whole
Officials from the Office of the State Courts Administrator (OSCA) state this proposal may
have some impact but there is no way to quantify that currently. Any significant changes will be
reflected in future budget requests.
Oversight does not have any information to the contrary. Oversight will reflect no fiscal impact
for this agency. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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Officials from the City of Kansas City assume the proposal would have a potential negative
fiscal impact of an indeterminate amount.
Oversight does not have any information to the contrary. As provided by OA, it is noted
possible litigation exposure could apply to local political subdivisions. Therefore, Oversight will
present a $0 to (Unknown) fiscal impact to local governments.
Officials from the Missouri House of Representatives (MHR) state the proposal will have no
impact, assuming the General Assembly will be in session when it needs to act.
Oversight does not have any information to the contrary. Oversight assumes the MHR will have
no fiscal impact based on their assumption.
Officials from the Office of Administration - Administrative Hearing Commission, the
Department of Commerce and Insurance, the Department of Economic Development, the
Department 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, Department of Corrections, the Department of Labor
and Industrial Relations, the Department of Revenue, the Department of Social Services,
the Missouri National Guard, the Office of the Governor, the Missouri Department of
Transportation, the MoDOT & Patrol Employees’ Retirement System, the City of
Springfield, the City of Urich, the Jackson County Board of Election Commissioners, the
Kansas City Board of Election Commissioners, the Platte County Election Authority, the St.
Louis County Board of Elections, the Newton County Health DepartmentPhelps
County Sheriff, the Branson Police DepartmentKansas City Police Department, the St.
Louis County Police Department, the Cole Camp Ambulance DistrictMissouri State
University, the Joint Committee on Public Employee Retirement, the Missouri Lottery
Commission, the Missouri Consolidated Health Care Plan the Department of Agriculture,
the Missouri Office of Prosecution Services, the Missouri State Employee's Retirement
System, the State Tax Commission, the Office of the State Auditor, Legislative Research, the
Oversight Division the Missouri Senate and the Office of the State Public Defender each
assume the proposal will have no fiscal impact on their respective organizations.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other cities, local election authorities, various county officials, local public health
agencies, nursing homes, police and sheriffs’ departments, fire protection districts, ambulance
and EMS, schools and charter schools, hospitals and colleges and universities were requested to
respond to this proposed legislation but did not. A listing of political subdivisions included in the
Missouri Legislative Information System (MOLIS) database is available upon request. L.R. No. 1261H.02C
Bill No. HCS for HB 489
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FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDIncome – AGO (§191.1805) – civil
penalties collected p.7$0 to Unknown$0 to Unknown$0 to Unknown
Costs – DMH – loss of training sites
(§191.1795) p.4-5
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Cost Increase – OA (§191.1802) –
Potential increase in transfer to LEF p.6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
OTHER STATE FUNDSCost Increase – OA (§191.1802) –
Potential increase in transfer to LEF p.6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
OTHER STATE FUNDS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
LEGAL EXPENSE FUND (0692)Transfer-in – Increase in appropriation
from General Revenue (§191.1802) p.6$0 to Unknown$0 to Unknown$0 to Unknown
Cost Increase – OA (§191.1802) –
Potential increase in transfer to LEF p.6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE LEGAL EXPENSE FUND$0$0$0 L.R. No. 1261H.02C
Bill No. HCS for HB 489
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FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026COLLEGES AND UNIVERSITIESCost Increase – Increase in LEF
payouts (§191.1802) p.6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Cost Increase – Restrictions on DEI
education in health care related
programs and compliance (§191.1795)
p.5-6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
COLLEGES AND UNIVERSITIES
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FEDERAL FUNDSLoss – DPS-MVC (§§191.230 and
292.648) – Reduction in federal funds
for non-compliance with CFR 59.110
p.3
$0 to
($287,500,000)
$0 to
($345,200,000)
$0 to
($345,200,000)
Loss – DMH (§191.1800) – Reduction
in federal funds for loss of accreditation
p.4
$0 to
($123,333,333)
$0 to
($148,000,000)
$0 to
($148,000,000)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS
$0 to
(Unknown,
potentially
exceeding
$410,833,333)
$0 to
(Unknown,
potentially
exceeding
$493,200,000)
$0 to
(Unknown,
potentially
exceeding
$493,200,000) L.R. No. 1261H.02C
Bill No. HCS for HB 489
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FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026LOCAL GOVENMENTSCost Increase – Increase in legal
payouts (§191.1802) p.6-8
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATE NET EFFECT ON
LOCAL GOVERNMENTS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FISCAL IMPACT – Small Business
This proposal could directly impact small business health care providers. (§§191.1770 to
191.1810)
FISCAL DESCRIPTION
No public body, political subdivision, public school district, state department or agency, public
official, peace officer, or person appointed by the Governor acting in an official capacity shall:
(1) Require any person to receive a COVID-19 vaccination;
(2) Condition any personal right or public service on a COVID-19 vaccination; or
(3) Impose any fine, tax, or criminal or civil penalty on a COVID19 vaccination.
The proposal contains exclusions for specified schools, health care facilities, and individuals
from the provisions regarding COVID-19 vaccinations.
Additionally, an employee shall be exempt from an employer's requirement to receive medical
treatment as a condition of employment and shall not be subject to adverse employment action
for declining to receive the treatment if:
(1) The employee holds a sincerely held religious belief that forbids the employee from receiving
the treatment and the reasonable accommodation of such belief would not pose an undue
hardship on the employer;
(2) The employee has received a written recommendation, based upon the employee’s unique
and individual situation, that a treatment is likely to be harmful to the employee or is not in the
best interest of the employee or is harmful for the employee according to a licensed physician
based on the employee's medical situation; and L.R. No. 1261H.02C
Bill No. HCS for HB 489
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(3) The employee submits a written request for the exemption to the employer.
Additionally, an student shall be exempt from a public college or university’s requirement to
receive medical treatment as a condition of participation in any project or activity sponsored by
the college or university and shall not be subject to adverse action by the college or university for
declining to receive the treatment if:
(1) The student holds a sincerely held religious belief that forbids the student from receiving the
treatment and the reasonable accommodation of such belief would not pose an undue hardship on
the college or university;
(2) The student has received a written recommendation, based upon the student’s unique and
individual situation, that a treatment is likely to be harmful to the student or is not in the best
interest of the student or is harmful for the student according to a licensed physician based on the
student’s medical situation; and
(3) The student submits a written request for the exemption to the college or university.
(§§191.230 and 292.648)
This bill establishes the "Do No Harm Act" and provides terms and definitions relating to
"academic standards", "health care related academic programs", "medical institutions of higher
education" and "Diversity-Equity-Inclusion" or "DEI" among others.
CERTIFICATION AND TRANSPARENCY (Section 191.1780) The bill requires medical
institutions of higher education to submit an annual certification by December 31st to the State
Board of Registration for Healing Arts, within the Department of Commerce and Insurance, and
the coordinating Board of Higher Education, within the Department of Higher Education, that
the institution does not require applicants or students to subscribe to DEI ideologies. This bill
requires medical institutions of higher education to publish titles and syllabi for all mandatory
courses, seminars, classes and trainings on a public online database, and prohibits institutions
from conducting DEI audits or hiring DEI consultants.
ASSESSMENTS AND STANDARDS (Section 191.1785) The bill requires medical institutions
of higher education to require applicants to complete a standardized admissions test and outlines
academic standards for health care related courses of study, as specified in the bill. If a medical
institution of higher education wants to alter the standards for admissions, the new standards
must be submitted to either chamber of the General Assembly and shall not be effective until at
least 60 days have passed during which a joint resolution of disapproval may be passed by both
chambers and approved by the Governor to invalidate any such submitted standards.
HEALTH CARE-RELATED DEI PROVISIONS (191.1790-191.1810) The bill restricts health
care-related professional licensing boards from any having any requirements for obtaining or
renewing licenses be associated with DEI related materials or programs. State-required health
care-related professional certifications shall not use DEI material or require DEI training as part L.R. No. 1261H.02C
Bill No. HCS for HB 489
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of the certification process. Such boards and organizations are prohibited from conducting DEI
audits or hiring DEI consultants.
Health care providers and medical institutions of higher education are prohibited from receiving
state contracts or grants without certifying that the provider or institution will not require
specified individuals from subscribing to, studying, or receiving instruction on DEI material.
Such providers and institutions must submit annual certification attesting to their compliance. All
state entities applying for any federal health care related grant relating to DEI shall publish on a
public website all materials, requirements, and instructions relating to the grant application along
with a copy of the grant proposal to the State Board of Registration for the Healing Arts and to
the members of the House and Senate Committees on Health Policy.
The bill provides any aggrieved person a cause of action for any violations of these sections to
include declaratory and injunctive relief, damages of at least $100,000 against the health care
provider or medical institution of higher education for any violations, compensatory damages,
and costs and attorney fees. Further the bill waives sovereign immunity for such providers and
institutions for up to a year after any violation.
The bill requires health care providers with more than 50 employees or any medical institution of
higher education to annually submit certification of compliance to the State Board of
Registration for the Healing Arts with Sections 191.1770 to 191.1810, RSMo, and authorizes the
Attorney General to investigate allegations of violations. In addition to any relief granted under a
private right to action, the Attorney General may seek civil penalties up to $1,000,000 against a
health care provider or medical institution of higher education for each violation of sections
191.1770 to 191.1810.
The State Board of Registration for the Healing Arts shall publish on its website annually a list
of all the health care providers and medical institutions that have provided annual certification.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space. L.R. No. 1261H.02C
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SOURCES OF INFORMATION
Attorney General’s Office
Office of Administration
Office of Administration - Administrative Hearing Commission
Department of Commerce and Insurance
Department of Economic Development
Department of Elementary and Secondary Education
Department of Higher Education and Workforce Development
Department of Health and Senior Services
Department of Mental Health
Department of Natural Resources
Department of Corrections
Department of Labor and Industrial Relations
Department of Revenue
Department of Public Safety –
Alcohol and Tobacco Control
Capitol Police
Fire Safety
Director’s Officer
Missouri Gaming Commission
Missouri Highway Patrol
Missouri Veterans Commission
State Emergency Management Agency
Department of Social Services
Missouri Department of Agriculture
Missouri National Guard
Office of the Secretary of State
Office of the State Public Defender
University of Central Missouri
Office of the Governor
Missouri Department of Transportation
MoDOT & Patrol Employees’ Retirement System
City of Kansas City
City of Springfield
City of Urich
Jackson County Board of Election Commissioners
Kansas City Board of Election Commissioners
Platte County Election Authority
St. Louis County Board of Elections
Newton County Health Department
Phelps County Sheriff
Branson Police Department L.R. No. 1261H.02C
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SOURCES OF INFORMATION (continued)
Kansas City Police Department
St. Louis County Police Department
Cole Camp Ambulance District
Missouri State University
Missouri House of Representatives
Joint Committee on Public Employee Retirement
Joint Committee on Administrative Rules
Legislative Research
Oversight Division
Missouri Senate
Office of the State Auditor
Missouri Lottery Commission
Missouri Consolidated Health Care Plan
Missouri Office of Prosecution Services
Missouri State Employee's Retirement System
State Tax Commission
Office of the State Courts Administrator
Julie MorffRoss StropeDirectorAssistant DirectorApril 3, 2023April 3, 2023