COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:5880H.01I Bill No.:HB 2883 Subject:Veterans; Health Care; Department of Public Safety; Boards, Commissions,
Committees, and Councils; Physicians; Health Care Professionals
Type:Original Date:April 8, 2024Bill Summary:This proposal enacts provisions relating to alternative treatment options for
veterans.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2025FY 2026FY 2027
General Revenue*
(Could exceed
$363,293)
(Could exceed
$363,420)
(Could exceed
$369,487)
Total Estimated Net
Effect on General
Revenue
(Could exceed
$363,293)
(Could exceed
$363,420)
(Could exceed
$369,487)
* The provisions at §42.0128.3 state the MVC “may” contract with institutions of higher
education, clinics or hospitals to provide services. It is assumed if MVC does contract with these
organizations that contract costs would exceed $250,000 annually.
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. 5880H.01I
Bill No. HB 2883
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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 2027General RevenueUp to 4 FTEUp to 4 FTEUp to 4 FTETotal Estimated Net
Effect on FTEUp to 4 FTEUp to 4 FTEUp to 4 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 2025FY 2026FY 2027Local Government$0$0$0 L.R. No. 5880H.01I
Bill No. HB 2883
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FISCAL ANALYSIS
ASSUMPTION
§42.018 – Alternative treatment options for veterans
Officials from the Department of Public Safety (DPS) - Missouri Veterans Commission
(MVC) state the proposal is assumed to have no fiscal impact on their organization. However,
there may be unspecified “expectations” that are not spelled out in the proposal that could cause
a fiscal impact.
Oversight assumes the provisions of this proposal could have a similar impact on the MVC as
HB 2215 (current session). Therefore, for fiscal note purposes, Oversight assumes the following
information provided by MVC for HB 2215 could be applicable:
In response to HB 2215, the MVC stated the “assume this bill would require MVC to review,
preapprove, obligate, pay, report, and audit the program on behalf of the Veterans in any
authorized facility throughout the state. This work would require the creation of a new section
within the Missouri Veterans Commission consisting of technicians with medical knowledge and
staff familiar with accounting that does not currently exist.
The MVC made the following assumptions:
currently have available - $103,000
The MVC anticipated a 6-month impact for 2025 of $363,293; an impact of $363,420 for FY
2026; and an impact of $369,487 for FY 2027.
Oversight notes the provisions between the current proposal and HB 2215 may give the MVC
some leeway in their implementation and they may not need all of the FTE requested in HB
2215. In addition, some of the provisions of §42.018 are permissive and it appears that the costs
of care would be the responsibility of the patient if they weren’t provided free of charge, thereby
possibly reducing the number of FTE needed to track information. Therefore, Oversight will
range the costs associated with the FTE as “Up to” the amounts provided by MVC.
In addition, it is unknown how much contracts with institutions of higher education or clinics or
hospitals may cost the MVC. Although the language is permissive (may contract), Oversight
assumes any contract costs would exceed $250,000 annually and will present costs as $0 to
(Unknown). L.R. No. 5880H.01I
Bill No. HB 2883
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Officials from the Department of Commerce and Insurance, the Department of Higher
Education and Workforce Development, the Department of Health and Senior Services, the
Department of Mental Health, the DPS – Director’s Office, the Department of Social
ServicesMissouri National Guard, the Newton County Health Department, Northwest
Missouri State University and the University of Central Missouri 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 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.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other local public health departments, hospitals, and colleges 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. L.R. No. 5880H.01I
Bill No. HB 2883
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FISCAL IMPACT – State GovernmentFY 2025
(6 Mo.)
FY 2026FY 2027GENERAL REVENUE FUNDCosts – DPS-MVC (§42.018) Personal
service (4 FTE), fringe benefits and
equipment and expenses p.3
(Up to
$363,293)
(Up to
$363,420)
(Up to
$369,487)
Contract costs$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Total Costs – DPS-MVC(Could exceed
$363,293)
(Could exceed
$363,420)
(Could exceed
$369,487)
FTE Change - MVCUp to 4 FTEUp to 4 FTEUp to 4 FTEESTIMATED NET EFFECT ON
THE GENERAL REVENUE FUND
(Could exceed
$363,293)
(Could exceed
$363,420)
(Could exceed
$369,487)
Estimated Net FTE Change on the
General Revenue FundUp to 4 FTEUp to 4 FTEUp to 4 FTE
FISCAL IMPACT – Local GovernmentFY 2025
(10 Mo.)
FY 2026FY 2027$0$0$0
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
This bill establishes the "Veterans Traumatic Brain Injury Treatment Act".
The bill allows the Veterans Commission to contract with public or private institutions of higher
education in this state, or public or private clinics or hospitals, to furnish alternative treatment
options for veterans who have been certified by the United States Department of Veterans
Affairs, any branch of the United States Armed Forces, or any state-licensed physician as having
a traumatic brain injury (TBI) or posttraumatic stress disorder (PTSD). The institution of higher L.R. No. 5880H.01I
Bill No. HB 2883
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education will manage, monitor, and ensure the compliance of contracted providers of any of the
following alternative treatment options: (1) Accelerated resolution therapy; (2) Equine therapy;
(3) Hyperbaric oxygen therapy, which will be provided at a registered and licensed hyperbaric
oxygen facility; (4) Music therapy; or (5) Service animal training therapy.
A veteran qualifies to receive alternative treatment under this bill if he or she: (1) Has been
diagnosed, by a health care practitioner, with service-connected posttraumatic stress disorder or a
service-connected traumatic brain injury; and (2) Voluntarily agrees to such alternative
treatment.
The provision of alternative treatment will be under the direction and supervision of an
individual licensed under this state to perform such alternative treatment. The supervising
licensed provider must agree to cooperate with the Veterans Commission to provide data
sufficient to assess the efficacy of alternative treatment modalities. Acceptable data may include,
but will not be limited to, institutional review board clinical trial data, pretreatment and post-
treatment MRI brain scans, cognitive testing such as the RightEye testing approved by the
United States Food and Drug Administration, Automated Neuropsychological Assessment
Metrics approved by the United States Department of Defense, and CNS Vital Signs metrics.
This bill specifies that a health care provider or health care facility shall make hyperbaric oxygen
therapy available to a military veteran who meets the requirements of this bill and who has
requested the therapy. The health care provider or health care facility may provide the hyperbaric
oxygen therapy without receiving compensation; require a military veteran to pay for the cost of
the hyperbaric oxygen therapy and any associated costs, at a rate that will not exceed the
maximum rate allowed by Medicare; or allow a military veteran to utilize alternative sources of
funding to cover the cost of the hyperbaric oxygen therapy and any associated costs, as provided
in the bill.
This bill specifies that a military veteran will be entitled to receive hyperbaric oxygen therapy if
the military veteran: (1) Has received a diagnosis of PTSD or TBI; (2) Has received an official
recommendation for hyperbaric oxygen therapy from the health care provider that treats the
eligible patient; and (3) Resides in this state.
A licensing board will not revoke, suspend, or fail to renew the license of a health care provider
or take any other punitive action against a health care provider, based on a recommendation or
counseling by the health care provider relating to access to or treatment with a hyperbaric
oxygen chamber for a military veteran.
No person acting on behalf of this state will block or attempt to block a military veteran from
receiving access to hyperbaric oxygen treatment.
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. 5880H.01I
Bill No. HB 2883
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SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Higher Education and Workforce Development
Department of Health and Senior Services
Department of Mental Health
Department of Public Safety –
Director’s Office
Missouri Veterans Commission
Department of Social Services
Missouri National Guard
Office of the Secretary of State
Newton County Health Department
Northwest Missouri State University
University of Central Missouri
Joint Committee on Administrative Rules
Julie MorffRoss StropeDirectorAssistant DirectorApril 8, 2024April 8, 2024