COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:4726H.01I Bill No.:HB 2221 Subject:Medicaid/MO HealthNet; Medical Procedures and Personnel; Hospitals; Workers
Compensation; Veterans
Type:Original Date:January 18, 2024Bill Summary:This proposal modifies provisions for providing copies of medical records.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 4726H.01I
Bill No. HB 2221
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2025FY 2026FY 2027Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2025FY 2026FY 2027Total 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 2025FY 2026FY 2027Local Government*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Reduction in medical record fees collected by local public health departments assumed to be
less than $250,000 annually. L.R. No. 4726H.01I
Bill No. HB 2221
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FISCAL ANALYSIS
ASSUMPTION
§191.227 – Copies of medical records
In response to a similar proposal from the previous session (HB 860), officials from the St.
Louis County Health Department stated their department could lose revenues if the proposal
passed. The average revenue for the last two years was $23,000, this would be less if this
proposal passed.
Oversight does not have any information to the contrary. Due to the minimal number of local
public health department responses, Oversight will reflect a $0 to (Unknown) loss of income to
local governments.
Officials from the Department of Commerce and Insurance, the Department of Health and
Senior Services, the Department of Mental Health, the Department of Labor and Industrial
Relations, the Department of Public Safety - Missouri Veterans Commission, the
Department of Social Services and the Newton 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, health departments and hospitals were requested to respond to this proposed legislation
but did not. A listing of political subdivisions included in the MOLIS database is available upon
request.
FISCAL IMPACT – State GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027$0$0$0 L.R. No. 4726H.01I
Bill No. HB 2221
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FISCAL IMPACT – Local GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027LOCAL GOVERNMENTSLoss – LPHAs (§191.227) – reduction
in medical record fees collected
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
LOCALGOVERNMENTS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FISCAL IMPACT – Small Business
This proposal may negatively impact small business health care providers. (§191.227)
FISCAL DESCRIPTION
This bill prohibits health care providers from charging a fee for medical records for use in
supporting an application for Workers' Compensation, Veterans, or Disability benefits. It does
allow health care providers to give the records in the most cost effective format, provided that
electronic records are given in a universally accessible format. (§191.227)
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 Health and Senior Services
Department of Mental Health
Department of Labor and Industrial Relations
Department of Public Safety – Missouri Veterans Commission
Department of Social Services
Newton County Health Department
St. Louis County Health Department
Julie MorffRoss StropeDirectorAssistant DirectorJanuary 18, 2024January 18, 2024