COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:0779H.05C Bill No.:HCS for SS for SCS for SB 157 Subject:Professional Registration and Licensing; Health Care Professionals; Nurses;
Social Workers; Physicians; Physical Therapists
Type:Original Date:April 25, 2023Bill Summary:This proposal modifies provisions relating to professions requiring licensure.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026General Revenue
Fund*
(Could exceed
$58,995)
(Could exceed
$35,831)
(Could exceed
$37,766)
Total Estimated Net
Effect on General
Revenue
(Could exceed
$58,995)
(Could exceed
$35,831)
(Could exceed
$37,766)
*The Health Professional Loan Incentive Program (§191.430 – §191.450) is subject to
appropriation (therefore reflected as “$0 or”) by the General Assembly. Along with the loss of
revenue on forgiven loans, unknown costs for the program are assumed to exceed $250,000
annually (if appropriated). L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 2 of
April 25, 2023
KC:LR:OD
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026
Board of Registration
for the Healing Arts
$0 or
(Could be less than
$257,062)
$0 or
(Could be less than
$264,160)
$0 or
(Could be less than
$265,693)
Social Workers Fund$0 or (Unknown)$0 or (Unknown)$0 or (Unknown)
Health Professional
Loan Incentive Fund*$0$0$0
Nurse Loan Fund($66,000)($1,300,000)($66,000)Board of Nursing
Fund $56,120$1,211,515$57,465
Colleges and
Universities
$0 to
Unknown
$0 to
Unknown
$0 to
Unknown
Committee of
Professional
Counselors Fund
(0672)
$0 or
($3,000 - $6,000)
$0 or
($3,000 - $6,000)
$0 or
($3,000 - $6,000)
Tattoo, Body Piercing
& Branding Fund
(0883) $11,500$12,500$500
Cosmetology and
Barber Exam Fund
(0785)
Unknown, Less than
$100,000
Unknown, Less than
$100,000
Unknown, Less than
$100,000Total Estimated Net
Effect on Other State
Funds
Less than
$101,620 to
(Could exceed
$171,442)
Less than $24,015 to
(Could exceed
$246,145)
Less than $91,965 to
(Could exceed
$179,728)
Numbers within parentheses: () indicate costs or losses.
*Income/appropriations and costs of loans distributed net to $0 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 3 of
April 25, 2023
KC:LR:OD
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Federal Funds*Total Estimated Net
Effect on All Federal
Funds $0$0$0
*Revenues and Expenses Net to Zero.
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2024FY 2025FY 2026Board of Registration
for the Healing ArtsUp to 3 FTEUp to 3 FTEUp to 3 FTE
Total Estimated Net
Effect on FTEUp to 3 FTEUp to 3 FTEUp to 3 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. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 4 of
April 25, 2023
KC:LR:OD
FISCAL ANALYSIS
ASSUMPTION
§§191.430 - 191.831 & 335.203 - 335.205 – Health professional loan repayment program
In response to a similar proposal from this year, (Perfected HB 542), officials from the
Department of Health and Senior Services (DHSS) stated the proposed legislation was written
in conjunction with a New Decision Item that would be necessary for successful implementation
of the legislative changes. This proposed legislation will require General Revenue (GR) to run
the Health Professional Loan Repayment Program, including funds for loan awards, based off
regular appropriation process.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect fiscal
impact as provided by DHSS.
DHSS stated in its FY2024 Budget Preview that it will transition fully to a loan repayment
program funding professionals and practitioners with educational debt for the purpose of paying
all or a portion of their existing educational loans.
The Primary Care Resource Initiative of Missouri (PRIMO) program addresses the needs of
areas with a shortage of health professionals by assisting in the development and expansion of
community-based health systems that provide medical, dental, and behavioral health services. In
addition, the PRIMO program provides forgivable student loans to health care professional
students who agree to work within shortage areas.
The Missouri Professional and Practical Nursing Student Loan (NSL) and Loan Repayment
Program (LRP) provides forgivable student loans to nursing students in exchange for service in
designated underserved communities and/or facilities that are experiencing nursing shortages
upon completion of training. The program also provides loan repayment to practicing nurses in
exchange for service in communities and/or facilities that are experiencing nursing shortages.
The Health Professional Loan and Health Professional Student Loan Repayment Program
provides educational loan repayment to practicing primary care medical and dental health
professionals in exchange for service in areas with a shortage of primary care medical and dental
professionals.
FY 2024 Governor’s Recommended Program funding for PRIMO, NSL and Loan Repayment
Programs:
GR $700,000
Fed $425,000
Other $2,256,790
Total $3,381,790 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 5 of
April 25, 2023
KC:LR:OD
FY 2020 Actual appropriations $3,131,542
FY 2021 Actual appropriation $3,310,292
FY 2022 Actual appropriations $3,060,540
FY 2023 Actual appropriations $3,181,790
Oversight notes that forgiveness of student loans includes the forgiveness of any accrued
interest associated with those loans while the health professional meets the service obligations
determined by DHSS.
Oversight assumes appropriations to the Health Professional Loan Repayment Program and
loans/expenses incurred by the program will net to $0.
In response to a similar proposal from this year, (Perfected HB 542), officials from the
Department of Revenue (DOR) stated this proposal will create a Health Professional Loan
Repayment Program that would provide certain taxpayers a loan. The loans are to be used to pay
off a qualified taxpayer’s student loan debt. The loans offered under this program are eligible for
forgiveness if certain criteria are met.
The Department of Health and Senior Services is the administrator of this program and has the
authority to set criteria for receipt of the loans.
It should be noted that under current federal law IRC Section 108(f)(1)-(2), income from the
discharge/forgiveness of a student loan from December 31, 2020 to January 1, 2026 is not
taxable. However, after January 1, 2026, such income may potentially be taxable. At this time,
DOR cannot determine how many students may receive these loans, how much of these loans
will be distributed, or if any of the loans received will be discharged/forgiven or when and,
therefore, the DOR is unable to determine an impact from this portion of the proposal. Any loss
would be unknown and would be considered foregone revenue.
This does not have an administrative impact on DOR.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect no
fiscal impact for this agency for these sections.
In response to a similar proposal from this year, (Perfected HB 542), officials from the
University of Central Missouri (UCM) stated this proposal would have an indeterminate fiscal
impact on UCM.
Oversight notes, in response to the previous version of this proposal, UCM indicated the
proposal could potentially increase revenue if it leads to increased enrollment. Therefore,
Oversight will reflect a $0 to Unknown increase in revenues for Colleges and Universities for
fiscal note purposes. L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 6 of
April 25, 2023
KC:LR:OD
In response to a similar proposal from this year, (Perfected HB 542), officials from the
University of Missouri Health Care System stated they had reviewed the proposed legislation
and has determined that as written it should not create expenses in excess of $100,000.
Oversight does not have any information to the contrary. Oversight assumes less than $100,000
in expenses to the University of Missouri Health Care is an amount that can be absorbed within
current funding levels and is not significant. Therefore, Oversight will reflect no fiscal impact for
the University of Missouri Health Care System.
In response to a similar proposal from this year, (Perfected HB 542), officials from the Office of
Administration, St. Charles Community College and the Office of the State Courts
Administrator each assumed the proposal would 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 for these sections.
In response to a similar proposal from this year, (Perfected HB 542), officials from the Office of
Administration - Budget and Planning deferred to the Department of Health and Senior
Services for response relating to the fiscal impact of this proposal on their organization.
Oversight notes a standard monthly payment (at current rates) for $100,000 in student loans
would be approximately $1,150, or $13,800 annually. To reach the $250,000 annual threshold,
the program would only have to include 19 participants (19 x $13,800 = $262,200). Oversight
assumes the $250,000 threshold, subject to appropriation, could be met in any given year.
§324.520 – Definition of Tattoo
Officials from the Department of Commerce and Insurance (DCI) estimate the following:
Initial Licensure
$8,500 85 Practitioners with a licensure fee of $100 (85 x $100) in FY 24
$3,000 15 Establishments with a licensure fee of $200 (15 x $200) in FY 24
$ 300 3 Practitioners with a licensure fee of $100 in FY 25 based upon a 3% growth rate
$ 200 1 Establishment with a licensure fee of $200 in FY25
$ 300 3 Practitioners with a licensure fee of $100 in FY 26 based upon a 3% growth rate
$ 200 1 Establishment with a licensure fee of $200 in FY26
Renewal
$8,800 88 Practitioners with a renewal fee of $100 (88 x $100) in FY 25
$3,200 16 Establishments with a renewal fee of $200 (16 x $200) in FY 25
The biennial renewal years for Tattoo licenses are FY 23 and FY 25. Licenses issued in FY 24
will renew in FY25.
FY 2024 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 7 of
April 25, 2023
KC:LR:OD
85 Practitioners at $100 fee = $8,500
15 Establishments at $200 fee = $3,000
Total - $11,500
FY 2025
88 Practitioners Renewal at $100 fee = $8,800
16 Establishments Renewal at $200 fee = $3,200
3 (3% growth rate) Practitioners at $100 fee =$300
1 (3% growth rate) Establishment at $200 fee = $200
Total - $12,500
FY 2026
3 (3% growth rate) Practitioners at $100 fee =$300
1 (3% growth rate) Establishment at $200 fee = $200
Total - $500
In summary, DCI assumes a Revenue of $11,500 in FY 2024, $12,500 in FY 2025 and $500 in
FY 2026 as a result of this proposal.
Oversight has no information to the contrary, therefore, Oversight will reflect the estimated
revenue provided by the DCI to the Tattoo, Body Piercing & Branding Fund (0883).
§§329.010 & 329.280 – Cosmetologist Personal Service Registration
Officials from the Department of Commerce and Insurance 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 for DCI for these sections.
Oversight assumes Section 329.280 allows any cosmetologist holding a current and active
license to register with the board for a “personal service registration”, along with submitting an
application and a fee (set by the board). Section 329.280 does not specify the fee amount,
however, Oversight assumes the revenue generated by this legislation will be minimal. For fiscal
note purposes, Oversight will reflect an “Unknown, less than $100,000” revenue into the
Cosmetology and Barber Exam Fund (0785).
§§335.036 and 335.056 - APRN
Officials from the Department of Commerce and Insurance (DCI) state it is estimated that to
fully investigate and prosecute complaints, the board may need additional resources. An
unknown cost of up to $100,000 from the Board of Nursing Fund may be necessary, depending
on the number of cases and legal expenses that occur.
Oversight assumes because the potential for litigation is speculative that the Department of
Commerce and Insurance will not incur significant cost related to this proposal. If a fiscal impact
were to result, the DCI may request additional funding through the appropriation process. L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 8 of
April 25, 2023
KC:LR:OD
Oversight contacted DCI officials and learned there are currently 14,673 registered APRNs in
Missouri. APRNs are required to pay a one-time fee of $150 for recognition of their APRN
status. DCI officials state this proposal does not change the fee structure or requirements related
to APRNs. The proposal instead changes the current APRN recognition model to a licensure
model.
§§335.203 - 335.257 – Nursing Education
§335.203.2
Officials from the Department of Health and Senior Services (DHSS) assume §335.203.2, of
the proposed legislation, proposes the removal of the $150,000 grant limit for those awarded
under the Nursing Education Incentive Program.
Oversight assumes removal of the $150,000 grant limit for those awarded the Nursing Education
Incentive Program in this subsection will have no fiscal impact on state or local government.
Oversight notes the Department of Commerce and Insurance (DCI) budget request included the
following information: The Nursing Education Incentive Program (NEIP) was established in
2011 through legislative action and appropriation of State Board of Nursing (Board) funds to
increase the number of nursing graduates by expanding the physical and educational capacity of
professional nursing programs in Missouri. This grant program is supported by nurse licensure
fees and represents continued action by the Board to support nursing education. The board
currently has the authority to award up to $2,000,000 each fiscal year for the NEIP Program.
This new decision item would allow the Board to award up to $3,000,000 each fiscal year in
NEIP funding. Oversight notes the DCI asked for a $1,000,000 new decision item from the State
Board of Nursing Fund (0635).
§335.205
DHSS also notes §335.205, of proposed legislation, proposes the collection of a nursing
education incentive program surcharge in addition to the nurse licensure fees for any initial nurse
license and license renewal application to be deposited into the state board of nursing fund.
Officials from the Department of Commerce and Insurance (DCI) state that the board projects
a 2% increase in licensees each year.
DCI assumes the surcharge only applies to applicants for a license by endorsement. (Those
numbers could decrease as more states join the nursing compact. Nurses will not need a Missouri
license because they are able to practice in Missouri on the license from the other state.)
DCI assumes the following:
FY 2024
LPN – Renewal Surcharge - $45,668
LPN – Initial License Surcharge $252
RN – Renewal Surcharge - $0 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 9 of
April 25, 2023
KC:LR:OD
RN – Initial Licensure Surcharge - $10,200
Total - $56,120
FY 2025
LPN – Renewal Surcharge - $0
LPN – Initial License Surcharge $260
RN – Renewal Surcharge - $1,200,850
RN – Initial Licensure Surcharge - $10,405
Total - $1,211,515
FY 2026
LPN – Renewal Surcharge - $46,582
LPN – Initial License Surcharge $268
RN – Renewal Surcharge - $0
RN – Initial Licensure Surcharge - $10,615
Total - $57,465
DCI Notes:
RNs are currently in renewal so the 120,085 number could decrease for multiple reasons:
- Licensees that retire and do not renew their license.
- Not having to renew due to the added nurse licensure compact states.
-This is the first renewal period since Kansas joined the nursing compact. The board does not
know how many RNs that are Kansas residents that will not renew their Missouri license because
they do not have to.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
revenues as estimated by the DCI to the Board of Nursing Fund (0635).
§335.212 - 335.242 (Removal)
DHSS also assumes this proposal, removes of §§335.212 through 335.242 which would
eliminate the Nursing Student Loan Program and §§335.245 through 335.257, which would
eliminate the Nursing Student Loan Repayment Program.
Additionally, eliminating §§335.212 through 335.257 would eliminate the established
Professional and Practical Nursing Student Loan and Nurse Loan Repayment Fund which is also
used to collect repayment and fees on any defaulted contracts. This section also gives the
authority to the DHSS to institute any action to recover any amount due. Therefore, the
Department may lose the authority to collect on bad debt from nurses who defaulted on their
loans.
Currently, the educational surcharge collected on nurse licensure and licensure renewal
applications is expended on administering the Nurse Student Loan (NSL) program and Nurse
Loan Repayment Program (NLRP). This fee is based on either the Registered Nurse (RN) or
Licensed Practical Nurse (LPN) and the year; the program receives $5 for each RN license L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 10 of 19
April 25, 2023
KC:LR:OD
during odd numbered years and then $1 from each LPN license during even numbered years. The
removal of these sections results in a loss of revenue that is utilized for the NSL program and
NLRP. If these funds are not received by DHSS, this would result in a loss of approximately
$1,300,000 on odd numbered years and $66,000 on even numbered years.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated loss provided by DHSS to the Nurse Loan Fund.
§§334.043 & 334.1600 -334.1720– Interstate Medical Licensure Compact
Officials from the Department of Commerce and Insurance (DCI) state that this legislative
language establishes Missouri as a member of the Interstate Medical Licensure Compact.
DCI assumes the following:
Licensee/Revenue
225 State of principal licensure applications (Board Estimate)
$75 License Fee
$100 Renewal Fee
175 Applications for letters of qualification (Board Estimate)
$300 ($300 of the $700 fee paid to the Compact for letters of qualification)
225 State of principal licensure applicants and 175 applications for letter of qualification.
under the PT Compact the licensee pays $25 for a license. The board receives $19 and the
Compact retains $6. At this time, DCI does not know what percentage, if any, the
Medical Compact will keep.
In summary, DCI assumes a revenue of $69,375 (225 applicants x $75 fee + 175 applicants for
letters of qualification x $300 onetime fee) in FY 2025 and $2,025 in FY 2026 to the Board of
Registration for the Healing Arts Fund (0634) as a result of the changes in this proposal.
The following board-specific expenses are being calculated to determine the additional
appropriation needed by the division to support the board and to assist in calculating the
anticipated license and renewal fees.
Staffing
1 Legal Counsel ($70,000/annually) needed to assist with implementation of the program
by assisting with any rules that are deemed necessary, responding to legal questions
pertaining to the qualifications for licensure, compact and investigations. Prepare L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 11 of 19
April 25, 2023
KC:LR:OD
documents for disqualified applicants who appeal the Board’s decision and serve as legal
advisors to the Board and its staff.
1 Customer Service Representative ($35,000/annually) needed to provide technical support,
process applications for licensure, and respond to inquiries related to the licensure law
and/or rules and regulations.
1 Non Commissioned Investigator ($38,000/annually) needed to conduct investigations and
inspections, serve notices, and gather information required by the board.
Complaints and Investigations
It is estimated the board will receive approximately 7 complaints. The division does not
anticipate receiving any complaints until FY 2025. It is estimated 30% of the complaints filed
will require field investigations with 50% requiring overnight travel. One car is needed to
conduct investigations and will need to be eventually replaced based upon usage. Therefore, the
vehicle cost is considered an ongoing expense and appropriation need.
Interstate Commission Annual Fee
The commission may charge participating boards an assessment if the projected revenue shortfall
is greater than 50% of the reserve fund at the time the budget is adopted. This amount is
unknown.
In summary, DCI assumes a cost of $257,062 in FY 2024, $264,160 in FY 2025 and $265,693 in
FY 2026 to provide for the implementation of the changes in this proposal.
Oversight assumes DCI is provided with core funding to handle a certain amount of activity
each year. Oversight assumes DCI could absorb some of the FTE costs related to this proposal.
Therefore, Oversight will reflect the cost and the FTE as “up to” the estimate provided by DCI to
the Professional Registration Fee Fund (0689).
Oversight will also reflect a possibility that not enough other states will join the Compact,
therefore, Oversight will reflect a $0 impact to Missouri until that threshold is reached.
Oversight notes that the balance in the Board of Registration for the Healing Arts Fund (0634)
was $8,663,267 as of December 2022.
Oversight notes the fiscal impact of this legislation differs from years past due to updated
estimates. The Board of Healing Arts does not currently have a $300 licensing fee, so it was
updated to a $75.00 License Fee and $100.00 Renewal fee.
§§334.100 - 334.613 – Physical Therapist Scope of Practice
Officials from the Department of Social Services (DSS) assume this legislation revises Chapter
334, RSMo, by adding three sections that would allow physical therapists to treat patients
without a prescription or referral from an approved health care provider. Since this legislation L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 12 of 19
April 25, 2023
KC:LR:OD
revises Chapter 334, RSMo, and since there is no specific exemption for physical therapists that
contract with the Health Maintenance Organizations (HMOs) that contact with the state to
provide health benefits to MO HealthNet managed Care members, it is assumed this will apply to
them.
The HMOs that contract with the state have current policies and procedures that outline
treatment guidelines for members for physical therapy services. This legislation revises current
language to remove the requirement for a prescription or referral from an approved healthcare
provider provided the physical therapist has a doctorate of physical therapy degree or has five
years of clinical practice as a physical therapist. In addition, this legislation revises language that
states consultation with an approved health care provider is not required if the course of physical
therapy services or treatment is completed within ten visits or twenty-one business days.
Providers enrolled with MO HealthNet must be licensed by the state in which they practice. In
order to receive reimbursement for services provided to a MO HealthNet participant, providers
must be enrolled with the state as a MO HealthNet provider. Physical therapy services must be
prescribed by a primary care provider and is only a covered benefit for children. Additionally,
any service included in the Individualized Education Program (IEP) developed through the
public school is covered through Fee-For-Service.
Medicaid’s requirement for medical necessity of physical therapy services would be impacted if
the need for prescription and referral by a primary care provider (or specialist) were removed. By
removing this connection to the primary care/specialist provider, utilization for these services
will inevitably increase over time due to provider induced demand, potential for over treatment
(due to lack of utilization controls), and difficulty in enforcement. In addition, utilization
increases may be expected based on the use of in-office ancillary. Without the need for a script
or other utilization control, utilization increases may be anticipated as clinicians have the ability
to bill up to ten visits before they must seek further consult, and without an enforcement process,
it is assumed this type of behavior will increase.
It is assumed that the Managed Care capitation rates would increase at least $100,000 based on
this legislation. For FY25 and FY26, a 5.4% medical inflation rate was used. They estimate the
actuarial cost to evaluate this program change to the Managed Care capitation rates to be no
more than $50,000.
FY24: Total - $150,000 (GR - $58,995; Federal - $91,005)
FY25: Total - $105,400 (GR - $35,831; Federal - $69,569)
FY26: Total - $111,092 (GR - $37,766; Federal - $73,326)
Oversight will reflect the cost as estimated by DSS. L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 13 of 19
April 25, 2023
KC:LR:OD
§§337.510 - 337.550 - Counseling Interstate Compact
Oversight assumes this legislation enacts the Counseling Interstate Compact.
Officials from the Department of Commerce and Insurance (DCI) state it is uncertain if the
compact would be enacted in FY24, FY25 or FY26. Once the compact is enacted the Division
would have the following fiscal impact: $3,000 to $6,000 estimated annual fees to participate in
the compact.
Oversight does not have any information to the contrary. Therefore, Oversight will reflect the
estimated fiscal impact as a range of $0 (the compact is not enacted) to $3,000 - $6,000 (the
compact is enacted) to the Committee of Professional Counselors Fund (0672).
§§337.615 - 337.1075 - Social Work Licensure Compact
Officials from the Department of Commerce and Insurance state it is uncertain if the compact
would be enacted in FY2024, FY2025 or FY2026. Once the compact is enacted, the Committee
for Social Workers would be required to pay fees charged to member states including an annual
assessment to cover costs of operations and activities of the compact commission. Costs are
unknown at this time.
Since the compact will only be effective once seven states have enacted legislation to join the
compact, Oversight will reflect a $0 (the compact is not enacted) to an unknown cost less than
$250,000 to the Social Worker Fund (0574).
Bill as a whole:
Officials from the Attorney General’s Office, the Department of Higher Education and
Workforce Development, the Department of Mental Health, the Department of Revenue,
the Department of Public Safety - Missouri Highway Patrol, the Missouri Department of
Transportation, the Missouri Consolidated Health Care Plan, the Missouri Office of
Prosecution Services and the Missouri State University 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.
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 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 14 of 19
April 25, 2023
KC:LR:OD
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.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUETransfer to – Health Professional Loan
Incentive Fund – appropriations
(§191.430) p.4-6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Cost – DSS
(§§334.100 - 334.613) p.11-12
Increase in Managed Care Capitation
Rates physical therapists (state portion)($33,995)($35,831)($37,766)
Actuarial Study (state portion)($25,000)$0$0ESTIMATED NET EFFECT TO
THE GENERAL REVENUE FUND
(Could exceed
$58,995)
(Could exceed
$35,831)
(Could exceed
$37,766)
FEDERAL FUNDSRevenue - DSS
(§§334.100 - 334.613) p.11-12
Increase in Managed Care Capitation
Rates$66,005$69,569$73,326
Actuarial Study$25,000$0$0Cost - DSS (§§334.100-334.613)
p.11-12
Increase in Managed Care Capitation
Rates (federal portion)($66,005)($69,569)($73,326)
Actuarial Study (federal portion)($25,000)$0$0ESTIMATED NET EFFECT TO
FEDERAL FUNDS$0$0$0 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 15 of 19
April 25, 2023
KC:LR:OD
BOARD OF REGISTRATION FOR
THE HEALING ARTS FUND (0634)
Revenue – DCI
§§334.1600 - 334.1720 p.10-11
interstate medical licensure compact$0$0 or $69,375$0 or $2,025
Cost – DCI –
§§334.1600 - 334.1720 p.10-11$0 or ….$0 or….$0 or….. Personal Service
(Up to
$119,167)
(Up to
$145,860)
(Up to
$148,777) Fringe Benefits(Up to $83,545)
(Up to
$101,324)
(Up to
$102,416)
Equipment and Expense(Up to $42,500)$0$0 Other Fund Cost(Up to $11,850)(Up to $16,976)(Up to $14,500)
Total Cost – DCI
Up to
($257,062)
(Up to
$264,160)
(Up to
$265,693)
FTE Change – DCIUp to 3 FTEUp to 9 FTEUp to 9 FTE
ESTIMATED NET EFFECT ON
BOARD OF REGISTRATION FOR
THE HEALING ARTS FUND (0634)
$0 or (Could
be less than
$257,062)
$0 or
(Could be less
than $264,160)
$0 or
(Could be less
than $265,693)
Estimated Net FTE Change to the
Board of Registration for the Healing
Arts Fund (0634)Up to 3 FTEUp to 3 FTEUp to 3 FTE
SOCIAL WORKER FUND (0574)Cost – DCI
(§§337.615 - 337.1075) p.13
Compact Cost
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown)
ESTIMATED NET EFFECT TO
THE SOCIAL WORKER FUND
(0574)
$0 or
(Unknown)
$0 or
(Unknown)
$0 or
(Unknown) L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 16 of 19
April 25, 2023
KC:LR:OD
HEALTH PROFESSIONAL LOAN
INCENTIVE FUND
Transfer in – from General Revenue –
appropriations (§191.430) p.4-6$0 to Unknown$0 to Unknown$0 to Unknown
Income – DHSS (§§191.430 – 191.831)
– Loan repayments/penalties for breach
of contract p.4-6$0 to Unknown$0 to Unknown$0 to Unknown
Costs – DHSS – Loans to health
professionals (§§191.430 - 191.831) p.4-
6
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE HEALTH PROFESSIONAL
LOAN INCENTIVE FUND*$0$0$0
*Income/appropriations and costs of loans distributed net to $0NURSE LOAN FUNDLoss – DHSS (§335.212 - 335.242)
Loss of educational surcharge
collection p.9-10($66,000)($1,300,000)($66,000)
ESIMATED NET EFFECT ON THE
NURSE LOAN FUND($66,000)($1,300,000)($66,000)
BOARD OF NURSING FUND (0635)Revenue – DCI (§335.205)
Nursing Education Incentive Program
Surcharge p.8-9$56,120$1,211,515$57,465
ESTIMATED NET EFFECT TO
THE BOARD OF NURSING FUND$56,120$1,211,515$57,465 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 17 of 19
April 25, 2023
KC:LR:OD
COLLEGES AND UNIVERSITIESIncome – Colleges & Universities –
increase in tuition and fees (§§191.430 -
191.831) p.4-6
$0 to
Unknown
$0 to
Unknown
$0 to
Unknown
ESTIMATED NET EFFECT ON
COLLEGES AND UNIVERSITIES
$0 to Unknown$0 to Unknown$0 to UnknownCOMMITTEE OF
PROFESSIONAL COUNSELORS
FUND (0672)
Cost – DCI §§337.510 - 337.550 (p.13)
Counseling Interstate Compact fees
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
ESTIMATED NET EFFECT TO
THE COMMITTEE OF
PROFESSIONAL COUNSELORS
FUND (0672)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
$0 or ($3,000-
$6,000)
TATTOO, BODY PIERCING &
BRANDING FUND (0883)
Revenue - DCI - definition change to
include more practitioners and
establishments §324.520 p. 6-7$11,500$12,500$500
ESTIMATED NET EFFECT TO
THE TATTOO, BODY PIERCING
& BRANDING FUND$11,500$12,500$500 L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 18 of 19
April 25, 2023
KC:LR:OD
COSMETOLOGY AND BARBER
EXAM FUND (0785)
Revenue – DCI §§329.010 & 329.280 Personal Service Registration Fee for
a personal service registration p. 6-7
Unknown, Less
than $100,000
Unknown, Less
than $100,000
Unknown, Less
than $100,000
ESTIMATED NET EFFECT TO
THE COSMETOLOGY AND
BARBER EXAM FUND (0785)
Unknown,
Less than
$100,000
Unknown,
Less than
$100,000
Unknown,
Less than
$100,000
FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026$0$0$0
FISCAL IMPACT – Small Business
Licensed Professional Counselors, health care providers and businesses who employ with
physicians with an expedited license could have a direct fiscal impact as a result of this proposal.
Licensed cosmetologist and/or a licensed cosmetology establishment could be impacted by this
proposal. Any small business that now falls into the new definition of tattoo will be fiscally
impacted by the proposed legislation.
FISCAL DESCRIPTION
This proposal modifies provisions relating to professions requiring licensure.
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
Attorney General’s Office
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Mental Health
Department of Public Safety
Missouri Highway Patrol
Department of Social Services
Missouri Department of Transportation L.R. No. 0779H.05C
Bill No. HCS for SS for SCS for SB 157
Page 19 of 19
April 25, 2023
KC:LR:OD
Office of Administration - Budget and Planning
Department of Revenue
Missouri Department of Conservation
Office of Administration
Office of the Secretary of State
Joint Committee on Administrative Rules
Missouri Consolidated Health Care Plan
Missouri Office of Prosecution Services
St. Charles Committee College
University of Central Missouri
University of Missouri Health Care System
Julie MorffRoss StropeDirectorAssistant DirectorApril 25, 2023April 25, 2023