COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1332H.02I Bill No.:HB 700 Subject:Health Care; Employees - Employers; Political Subdivisions; Health, Public Type:Original Date:February 22, 2023Bill Summary:This proposal creates provisions relating to refusal of medical procedures or
treatment.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue
Fund*
$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 notes this proposal could possibly create exposure for the state government and/or
local political subdivisions.
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Other State Funds$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)Legal Expense Fund*$0 $0 $0 Colleges and
Universities
$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)
*LEA Fund will net to zero.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1332H.02I
Bill No. HB 700
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Federal 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)
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 or (Unknown)$0 or (Unknown)$0 or (Unknown) L.R. No. 1332H.02I
Bill No. HB 700
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FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Mental Health (DMH) assume this proposal adds
sections 191.230 and 292.648 prohibiting a public body and employers in the state from
requiring individuals to receive a COVID-19 vaccination. It also prohibits medical treatment
as a condition of employment if the individual has religious or medical reason for exemption.
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 requirement
may put some DMH facilities and agencies at odds with federal requirements for licensure
and/or CMS funding. This proposal will have an unknown impact on DMH.
In response to the similar proposal, HB 1686 – 2022, officials from the Attorney General’s
Office noted that there is a theoretical possibility that this proposal could have an impact on the
Legal Expense Fund (LEF) for various agencies throughout the state.
Oversight notes most LEF costs are reimbursed from the General Revenue Fund (GR). GR has
paid for the majority of payments from the LEF since payments on LEF cases for agencies with
designated reimbursable funds have been relatively small. According to Office of Administration
- Risk Management (OARM), broader budget authority to transfer from Federal and Other Funds
beginning in FY 18 allowed for an increase of percentage of payments from Federal and Other
Funds.
Oversight does not have any information to the contrary in regards to DMH and AGO’s
assumptions; therefore, Oversight will range the fiscal impact from $0 (does not increase
litigation) to an “Unknown” cost (increased claims related to potential litigation claims for
various state agencies) on the fiscal note. Depending on the litigation the cost could exceed
$250,000.
Officials from the Missouri Department of Transportation (MODOT) assume the proposal
will have no fiscal impact on their organization. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact in the fiscal note.
Officials from the Department of Public Safety – Highway Patrol (DPS-MSHP) defer to the
MoDOT for the potential fiscal impact of this proposal.
Officials from 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 Department of Mental Health, the Department of Natural Resources, the
Department of Corrections, the Department of Labor and Industrial Relations, the L.R. No. 1332H.02I
Bill No. HB 700
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Department of Revenue, the Department of Public Safety (Office of the Director, Capitol
Police, Alcohol & Tobacco Control, Fire Safety, Gaming Commission, Missouri National
Guard, State Emergency Management Agency and Veterans Commission the Department
of Social Services, the Office of the Governor, the Joint Committee on Administrative
Rules, the Joint Committee on Public Employee Retirement, the Missouri Lottery
Commission, the Missouri Consolidated Health Care Plan the Department of Agriculture,
the Missouri Department of Conservation, the Missouri Ethics Commission, the Missouri
House of Representatives, the Department of Transportation, the Office of Prosecution
Services Office of AdministrationAdministrative Hearing Commission and Budget
and Planning), the Office of the State Courts Administrator, the Office of the State Auditor,
the Missouri Senate the Office of the Secretary of State, the Office of the State Public
Defender, the Office of the State Treasurer State Tax Commission each assume the
proposal will have no fiscal impact on their respective organizations.
Officials from Office of Administration – Budget & Planning (B&P) assume the proposal has
no direct impact on B&P. The proposal has no direct impact on general or total state revenues;
therefore, not impact the calculation pursuant to Art. X, Sec. 18(e).
Officials from the above referenced organizations assume the proposal will have no fiscal impact
on their organizations. Oversight does not have any information to the contrary. Therefore,
Oversight will reflect a zero impact in the fiscal note for these organizations.
Officials from the University of Central Missourihis legislation could have an
indeterminate amount of impact on the University.
In response to the similar proposal, HB 1686 – 2022, officials from the Northwest Missouri
State University note the University were unable to determine fiscal impact at this time;
however, it would be contingent upon Federal mandates affecting grants and government grant
fund recipients.
In response to the similar proposal, HB 1686 – 2022, officials from the Missouri University
System noted that if the federal mandate is upheld by the courts and this bill prohibits
compliance with the federal mandate, the university would lose in excess of $76 million of
federal contracts. If the federal mandate is upheld as a condition of participation in Medicare and
Medicaid and this bill prohibits compliance with the federal mandate, it could result in a loss of
$547.4 million annually.
Officials from the Missouri University System assume the proposal will have potential direct
fiscal impact on their organization. Oversight does not have any information to the contrary.
Therefore, Oversight will reflect above organizations impact of “Unknown” reduction in federal
revenue on the fiscal note.
Oversight assumes the proposal will potentially require additional expenditures due to the
increased exposure to liability for colleges, universities, and political subdivisions. Therefore, L.R. No. 1332H.02I
Bill No. HB 700
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Oversight will range a negative fiscal impact from $0 (no lawsuit was brought against above
organizations) or unknown (lawsuit increased exposure to liability to above organizations) on the
fiscal note.
Officials from the City of Kansas City, the City of O’Fallon, 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 cities.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUECost - Potential increase in payments to
Legal Expense Fund for increase in
claims (p.3)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT TO
GENERAL REVENUE FUND
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
OTHER STATE FUNDSCost - Potential increase in payments to
Legal Expense Fund for increase in
claims (p.3)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT TO
OTHER STATE FUNDS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
FEDERAL FUNDSLoss of Federal Funds for Colleges &
Universities (p.3)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
Cost - Potential increase in claims$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT TO
FEDERAL FUNDS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown) L.R. No. 1332H.02I
Bill No. HB 700
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LEGAL EXPENSE FUND (0692)Transfer In - from GR, Federal, and
Other State Funds Potential increase in
claims (p.3)
$0 or Unknown$0 or Unknown$0 or UnknownTransfer Out - payment of
discrimination claims
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT TO
THE LEGAL EXPENSE FUND
$0$0$0COLLEGES AND UNIVERSITIESCost - Colleges and Universities
Potential increase in legal claims (p.5)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT ON
COLLEGES AND UNIVERSITIES
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026LOCAL POLITICAL SUBDIVISIONSCost - Potential increase in legal claims
(p.5)
$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)ESTIMATED NET EFFECT TO
LOCAL POLITICAL SUBDIVISIONS
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
FISCAL IMPACT – Small Business
A fiscal impact to small businesses would be expected as a result of this proposal. L.R. No. 1332H.02I
Bill No. HB 700
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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.
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; or
(2) The vaccine is harmful for the employee according to a licensed physician based on the
employee's medical situation. An employee whose rights under this provision have been violated
shall be eligible for Workers' Compensation for any injuries sustain
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 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
Department of Social Services
Office of the Governor
Joint Committee on Public Employee Retirement
Joint Committee on Administrative Rules
Missouri Lottery Commission L.R. No. 1332H.02I
Bill No. HB 700
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Legislative Research
Oversight Division
Missouri Consolidated Health Care Plan
Missouri Department of Agriculture
Missouri Department of Conservation
Missouri Ethics Commission
Missouri House of Representatives
Office of the Lieutenant Governor
Missouri Department of Transportation
Missouri State Employee's Retirement System
MoDOT & Patrol Employees’ Retirement System
Missouri Office of Prosecution Services
Office of Administration
Office of the State Courts Administrator
Office of the State Auditor
Missouri Senate
Office of the Secretary of State
Office of the State Public Defender
Office of the State Treasurer
City of Kansas City
City of O’Fallon
City of Springfield
University of Central Missouri
Julie MorffRoss StropeDirectorAssistant DirectorFebruary 22, 2023February 22, 2023