COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1080S.01I Bill No.:SB 24 Subject:Emergencies; Department of Health and Senior Services; Mental Health;
Department of Mental Health; Department of Public Safety; Insurance - Health;
Health Care; Fire Protection; Law Enforcement Officers and Agencies Employees
- Employers; Suicide
Type:Original Date:January 27, 2023Bill Summary:This proposal creates the "Missouri First Responder Mental Health Initiative
Act".
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2024FY 2025FY 2026
General Revenue*
$0 to ($174,848 to
Unknown)
$0 to ($200,760 to
Unknown)
$0 to ($204,150 to
Unknown)
Total Estimated Net
Effect on General
Revenue
$0 to ($174,848 to
Unknown)
$0 to ($200,760 to
Unknown)
$0 to ($204,150 to
Unknown)
*The proposal provides that the General Assembly may appropriate moneys to the Missouri First
Responders Behavioral Mental Health Fund for grants to be distributed to state and local first
responder organizations for mental health services. Oversight will reflect this appropriation as $0
to (Unknown). The amounts reflected above are for the Department of Mental Health to
administer the program only (doesn’t include the grant appropriation – which is reflected as an
‘unknown’ amount). If appropriated, the fiscal impact would exceed the $250,000 threshold.
This proposal also could create claims and damages that could potentially be asserted against the
state or other entities. If such claims were successfully pursued, they could result in additional
costs to the state or local political subdivision. Oversight assumes the number of claims would be
minimal and would not reach the $250,000 threshold.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1080S.01I
Bill No. SB 24
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ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Other State$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)LEF* $0$0$0First Responder
Behavioral Health
Grant* $0$0$0
Colleges 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 that net to zero.
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2024FY 2025FY 2026Federal$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Total Estimated Net
Effect on All Federal
Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2024FY 2025FY 2026General Revenue2 FTE2 FTE2 FTETotal Estimated Net
Effect on FTE2 FTE2 FTE2 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 to (Unknown)$0 to (Unknown)$0 to (Unknown) L.R. No. 1080S.01I
Bill No. SB 24
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FISCAL ANALYSIS
ASSUMPTION
§§190.1010 and 190.1015 – Missouri first responder mental health initiative act
Officials from the Department of Mental Health (DMH) state §190.1010 creates the "First
Responder Behavioral Health Grant Program" to be created within the DMH, and the “First
Responder Behavioral Health Grant Fund” to be used solely by DMH. These grants would be
directed toward local governments, 911 dispatch agencies, law enforcement agencies, fire
protection districts, municipal fire departments, ambulance districts, Missouri State Council of
Fire Fighters peer support teams, and Missouri Fraternal Order of Police peer support teams.
The grant funds shall be used for expenses related to behavioral health care services for first
responders; however, it is unclear what cash source will support the fund for these expenses.
Section 190.1015 creates the “Missouri First Responders Mental Health Task Force”. The DMH
director or designee shall be a member of this task force, as well as two different mental health
organizations appointed by the DMH Director. This task force shall develop recommendations
regarding the grants issued under the First Responder Behavioral Health Grant Fund.
The creation of the First Responder Behavioral Grant Program within the DMH would require
two additional FTEs. These positions would be responsible for developing and running the grant
program and all duties related to this program. The total estimated cost for FY24 is $174,848,
FY25 is $200,760 and FY26 is $204,150.
Oversight does not have any information to the contrary and will reflect the General Revenue
expenditures estimated by DMH. Oversight assumes grants provided by the DMH to qualifying
recipients will equal the appropriations received and the net impact to the First Responder
Behavioral Health Grant Fund will be zero. The amount of the appropriation is $0 to Unknown.
In addition, Oversight assumes the expenditures incurred by eligible recipient organizations will
equal the grant funds received and the net effect on the various state funds and local governments
receiving the grants will be zero.
Officials from the Department of Public Safety (DPS) – Director’s Office (DO) state 0.5 FTE
will provide admin support per §190.1015.2 to the Missouri First Responders Mental Health
Task Force. FY24 expenses to the General Revenue Fund are expected to be $29,969; FY25
$32,811; and FY26 $33,312.
Oversight assumes the DPS-DO would not hire 0.5 FTE and will allocate the duties and
responsibilities for the Missouri First Responders Mental Health Task Force to existing staff.
Depending on the number of bills passed during the legislation session, cumulatively, DPS may
need additional staff or funding and may go through the appropriations process. L.R. No. 1080S.01I
Bill No. SB 24
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Officials from the Office of Administration (OA) state the provisions of §191.1010.4 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.
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.
Officials from the University of Central Missouri (UCM) state this proposal will have an
indeterminate fiscal impact due to uncertainty of potential insurance cost changes.
Oversight does not have any information to the contrary. However, Oversight assumes any
potential change to insurance premiums will be minimal and absorbable within the current
funding levels of UCM.
Officials from the Department of Corrections, the Department of Labor and Industrial
Relations, the Department of Public Safety Divisions of: Alcohol and Tobacco Control
Capitol Police, Fire Safety Missouri National Guard and Missouri Highway Patrol
Phelps County Sheriff’s Department, the Kansas City Police Department, the St. Joseph
Police Department, the St. Louis County Police Department, the Fruitland Area Fire
Protection District – Cape Girardeau, St. Charles Community College and the Office of the
State Courts Administrator
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 L.R. No. 1080S.01I
Bill No. SB 24
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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.
Officials from the Office of the State Treasurer (STO) did not respond to Oversight’s request
for a statement of fiscal impact.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other sheriffs’ and police departments, fire protection districts, ambulance & EMS
districts, 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.
FISCAL IMPACT – State GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026GENERAL REVENUE FUNDTransfer-out – to First Responder
Behavioral Health Grant Fund
(§190.1010) p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Costs – DMH (§190.1010) p.3$0 to…$0 to….$0 to…. Personal service($94,583)($115,770)($118,085) Fringe benefits($61,362)($74,484)($75,350) Equipment and expense($18,903)($10,506)($10,715)Total Costs – DMH($174,848)($200,760)($204,150) FTE Change – DMH2 FTE2 FTE2 FTECost Increase – OA (§190.1010) –
Potential increase in transfer to LEF p.4
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND
$0 to ($174,848
to Unknown)
$0 to ($200,760
to Unknown)
$0 to ($204,150
to Unknown)
Estimated Net FTE Change on the
General Revenue Fund2 FTE2 FTE2 FTE L.R. No. 1080S.01I
Bill No. SB 24
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FISCAL IMPACT – State Government
(continued)
FY 2024
(10 Mo.)
FY 2025FY 2026OTHER STATE FUNDSTransfer-in – from First Responder
Behavioral Health Grant Fund
(§190.1010) p.3$0 to Unknown$0 to Unknown$0 to Unknown
Cost Increase – OA (§190.1010) –
Potential increase in transfer to LEF
(§190.1010) p.4
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Costs – First Responder Behavioral
Health expenditures (§190.1010) p.3
$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 (§190.1010) p.3$0 to Unknown$0 to Unknown$0 to Unknown
Cost increase – Increase in LEF payouts
(§190.1010) p.4
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE LEGAL EXPENSE FUND$0$0$0 L.R. No. 1080S.01I
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FISCAL IMPACT – State Government
(continued)
FY 2024
(10 Mo.)
FY 2025FY 2026FIRST RESPONDER
BEHAVIORAL HEALTH GRANT
FUND
Transfer-in – from General Revenue for
First Responder Behavioral Health
Grants (§190.1010) p.3$0 to Unknown$0 to Unknown$0 to Unknown
Transfer-out – to Other State Funds for
First Responder Behavioral Grants
(§190.1010) p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Transfer-out – to Local Governments
for First Responder Behavioral Grants
(§190.1010) p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
THE FIRST RESPONDER
BEHAVIORAL HEALTH GRANT
FUND $0$0$0
COLLEGES AND UNIVERSITIESCost increase – Increase in LEF payouts
(§190.1010) p.4
$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) L.R. No. 1080S.01I
Bill No. SB 24
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FISCAL IMPACT – Local GovernmentFY 2024
(10 Mo.)
FY 2025FY 2026LOCAL GOVERNMENTSTransfer – in – from First Responder
Behavioral Health Grant Fund
(§190.1010) p.3$0 to Unknown$0 to Unknown$0 to Unknown
Costs – First Responder Behavioral
Health program expenditures
(§190.1010) p.3
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Cost increase – Increase in legal
payouts (§190.1010) p.4
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
LOCAL GOVERNMENTS$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FISCAL IMPACT – Small Business
This proposal may have a fiscal impact on small business health care providers. ((§190.1010)
FISCAL DESCRIPTION
This act establishes the "Missouri First Responder Mental Health Initiative Act". This act
establishes the rights of first responders to access behavioral health care services and responsive
treatment and to have certain records of such treatment be deemed confidential, as specified in
the act, and shall not be shared with an employer. First responders shall have the right to seek
treatment in any geographic area without restrictions or limitations imposed by an employer or
insurance carrier and the right to receive expanded Family and Medical Leave Act protections
while voluntarily seeking preventative treatment. First responders shall have the right to have
treatment and living quarters in facilities separate from other patients, as well as access to
behavioral health treatment for up to 36 months following retirement regardless of Medicare
restrictions.
First responders receiving behavioral health services shall be able to seek reimbursement from
the First Responder Behavioral Health Grant Program established by this act, in amounts
specified in the act. The Department of Mental Health shall make grants to eligible recipients to L.R. No. 1080S.01I
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reimburse behavioral health care expenses, as well as peer support education, prevention and
awareness training, software, and other services. (§190.1010)
Additionally, this act establishes the "Missouri First Responders Mental Health Task Force"
within the Department of Public Safety, with specified members of the mental health and first
responder community, to develop recommendations set forth in the act, including access to
mental health wellness programs and initiatives, funding for services, education and training
programs.
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 Mental Health
Department of Corrections
Department of Labor and Industrial Relations
Department of Public Safety –
Alcohol and Tobacco Control
Capitol Police
Fire Safety
Missouri National Guard
Missouri Highway Patrol
Office of Administration
Office of the Secretary of State
Phelps County Sheriff’s Department
Kansas City Police Department
St. Joseph Police Department
St. Louis County Police Department
Fruitland Area Fire Protection District – Cape Girardeau
University of Central Missouri
St. Charles Community College
Joint Committee on Administrative Rules
Julie MorffRoss StropeDirectorAssistant DirectorJanuary 27, 2023January 27, 2023