COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1957H.01I Bill No.:HB 944 Subject:Nursing Homes and Long-Term Care Facilities; Department of Health and Senior
Services
Type:Original Date:March 13, 2023Bill Summary:This proposal creates provisions relating to attendant call systems in
residential care facilities and assisted living facilities.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue($97,487)($118,085)$0Total Estimated Net
Effect on General
Revenue($97,487)($118,085)$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 1957H.01I
Bill No. HB 944
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2024FY 2025FY 2026General Revenue1 FTE1 FTE0 FTETotal Estimated Net
Effect on FTE1 FTE1 FTE0 FTE
☐ 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. 1957H.01I
Bill No. HB 944
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FISCAL ANALYSIS
ASSUMPTION
§198.078 – Attendant call systems in residential/assisted living facilities
Officials from the Department of Health and Senior Services (DHSS) state
§198.078.1 requires all assisted living facilities (ALF) and residential care facilities (RCF)
operating within the state to be equipped with an attendant call system consisting of an electrical
intercommunication system, a wireless pager system, a buzzer system, or hand and analog bells.
Section 198.078.2 further requires the mechanism for calling attendants to be located in each
toilet room and resident bedroom.
Current regulations require all assisted living facilities and all residential care facilities whose
plans are approved, or which are initially licensed for more than twelve (12) residents after
December 31, 1987, be equipped with a call system consisting of an electrical
intercommunication system, a wireless pager system, buzzer system or hand bells. An acceptable
mechanism for calling attendants shall be located in each toilet room and resident bedroom. Call
systems for facilities whose plans are approved, or which are initially licensed after December
31, 1987, shall be audible in the attendant’s work area. Proposed 198.078.4 requires the call
system to be designed in a manner that records the length of time that elapses between the call
and the response to the call by the attendant and generation of logs of response times. It is
unknown if any current systems meet this requirement; therefore, cost estimate is based on all
625 RCF/ALF licensed facilities.
It is assumed it will take an Associate Engineer ($73,131) approximately 5 hours per licensed
RCF and ALF to review physical plant designs for the installation of the electrical
intercommunication system, wireless pager system, buzzer system or hand bells to ensure the
system being installed is in accordance with promulgated regulations and state law, including
system design. Currently, DHSS licenses 625 RCF/ALF facilities, which would equal 3,125
hours. Based on 2,080 working hours per year, this would require one (1) temporary FTE
approximately two years to review facility plans for compliance. It is assumed an Associate
Engineer would be hired around September 2023, for a total personal service cost of $54,849
($73,131 x 9/12) in FY 24 and $74,594 ($73,131 x 1.02) in FY25.
Thereafter, approximately 100 hours (5 hours x 20 new construction projects) per year will be
required to review new construction for system requirements. Based on 2,080 working hours per
year, this would require 0.048 FTE to assume these duties (100 hours ÷ 2,080 hours per year =
0.048) for a total personal service cost of $3,510 ($73,131 x 0.048) per year after FY25. It is
assumed that the Department can absorb the costs of this FTE with current resources. However,
if the workload significantly increased or other legislation was enacted, additional resources
would be requested through the appropriation process. L.R. No. 1957H.01I
Bill No. HB 944
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Section 198.078.5 requires the DHSS to establish a standard for the maximum length of time
allowed to elapse between a call made by a resident using the attendant call system and the
response to the call by the attendant.
Oversight assumes DHSS would not need additional rental space for 1 new temporary FTE for
this single proposal. Oversight further assumes the DHSS will have sufficient staff and resources
available to monitor newly built and licensed RCF/ALF facilities for compliance with the
provisions of this proposal within appropriation levels once the review of current facilities has
been completed (beyond FY 2025).
Officials from the Department of Social Services, the City of Kansas City, the Newton
County Health Department and the St. Louis County Health Department 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.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other local public health departments and nursing homes 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.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDCosts – DHSS (§198.078) Personal service($54,848)($74,594)$0 Fringe benefits($32,208)($43,491)$0 Equipment end expense($10,431)$0$0Total Costs – DHSS($97,487)($118,085)$0 FTE Change - DHSS 1 FTE1 FTE0 FTEESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND($97,487)($118,085)$0
Estimated Net FTE Change on the
General Revenue Fund 1 FTE1 FTE0 FTE L.R. No. 1957H.01I
Bill No. HB 944
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FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0
FISCAL IMPACT – Small Business
This proposal will directly impact small business RCF/ALFs as they may be required to update
their current communication systems. (§198.078)
FISCAL DESCRIPTION
This bill requires that all assisted living facilities and residential care facilities equip, in each
toilet room and resident bedroom as well as the attendant's work area, an attendant call system
that consists of an electrical intercommunication system, a wireless pager system, a buzzer
system, or hand and analog bells.
For every call made by a resident using the system, the length of time that elapses between the
call and the response to the call by the attendant must be recorded, and a log of such response
times must be available to the Department of Health and Senior Services during any inspection.
The Department shall establish a standard for the maximum allowable length of time to elapse
between a call made by a resident using the call system and the response to the call by the
attendant. Any failure by a facility to meet this standard shall be considered a deficiency to be
noted in the survey report. (§198.078)
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. 1957H.01I
Bill No. HB 944
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SOURCES OF INFORMATION
Department of Health and Senior Services
Department of Social Services
Newton County Health Department
St. Louis County Health Department
City of Kansas City
Julie MorffRoss StropeDirectorAssistant DirectorMarch 13, 2023March 13, 2023